TY - JOUR
T1 - Appendectomy versus observation for appendicitis in neutropenic children with cancer
AU - PEDIATRIC SURGICAL ONCOLOGY RESEARCH COLLABORATIVE
AU - Many, Benjamin T.
AU - Lautz, Timothy B.
AU - Dobrozsi, Sarah
AU - Wilkinson, Katheryn Hope
AU - Rossoff, Jenna
AU - Le-Nguyen, Annie
AU - Dakhallah, Nawar
AU - Piche, Nelson
AU - Weinschenk, Whitney
AU - Cooke-Barker, Jo
AU - Goodhue, Catherine
AU - Zamora, Abigail
AU - Kim, Eugene S.
AU - Talbot, Lindsay J.
AU - Quevedo, Oswaldo Gomez
AU - Murphy, Andrew J.
AU - Commander, Sarah J.
AU - Tracy, Elisabeth T.
AU - Short, Scott S.
AU - Meyers, Rebecka L.
AU - Rinehardt, Hannah N.
AU - Aldrink, Jennifer H.
AU - Heaton, Todd E.
AU - Ortiz, Michael V.
AU - Baertschiger, Reto
AU - Wong, Kaitlyn E.
AU - Lapidus-Krol, Eveline
AU - Butter, Andreana
AU - Davidson, Jacob
AU - Stark, Rebecca
AU - Ramaraj, Akila
AU - Malek, Marcus
AU - Mastropolo, Rosemarie
AU - Morgan, Katrina
AU - Murphy, Joseph T.
AU - Janek, Kevin
AU - Le, Hau D.
AU - Dasgupta, Roshni
AU - Lal, Dave R.
N1 - Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
PY - 2021/2/1
Y1 - 2021/2/1
N2 - BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration. METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period. RESULTS: Sixty-six children, with a median age of 11 years (range 1-17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P =.23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P =.05) and longer LOS (29 vs 12 days; P =.01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P,.01). CONCLUSIONS: In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management.
AB - BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration. METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period. RESULTS: Sixty-six children, with a median age of 11 years (range 1-17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P =.23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P =.05) and longer LOS (29 vs 12 days; P =.01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P,.01). CONCLUSIONS: In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management.
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U2 - 10.1542/peds.2020-027797
DO - 10.1542/peds.2020-027797
M3 - Article
C2 - 33504609
AN - SCOPUS:85101298938
SN - 0031-4005
VL - 147
JO - Pediatrics
JF - Pediatrics
IS - 2
M1 - e2020027797
ER -